Yonsei Med J.  2013 Nov;54(6):1491-1497. 10.3349/ymj.2013.54.6.1491.

Comparative Study for Preventive Effects of Intra-Abdominal Adhesion Using Cyclo-Oxygenase-2 Enzyme (COX-2) Inhibitor, Low Molecular Weight Heparin (LMWH), and Synthetic Barrier

• Kim YI

• KMID: 1798148
• DOI: http://doi.org/10.3349/ymj.2013.54.6.1491

Abstract

PURPOSE
Postoperative adhesion is the most frequent complication of abdominal surgery. Therefore, we investigated the individual effects of synthetic barrier [hyaluronic acid/carboxymethylcellulose (HA/CMC)] and pharmacologic agents [low molecular weight heparin (LMWH) cyclo-oxygenase-2 inhibitor (COX-2 inhibitor)] using animal model of intra-abdominal adhesion.
MATERIALS AND METHODS
The cecum was rubbed with sterile alcohol wet gauze until subserosal haemorrhage and punctate bleeding developed under the general anesthesia. Five animal groups were prepared using the film HA/CMC, gel HA/CMC, LMWH and COX-2 inhibitor.
RESULTS
The grade of adhesion by modified Leach method for group I (control), II (film type HA/CMC), III (gel type HA/CMC), IV (LMWH) and V (COX-2 inhibitor) were 5.35+/-1.8, 6.15+/-1.3, 4.23+/-2.6, 5.05+/-0.7 and 5.50+/-0.9, respectively. Group III showed the least grade of adhesion and it is statistically significant in adhesion formation (p=0.028). The numbers of lymphocytes were significantly low in group III and group V compared to the control group (lymphocyte: p=0.004). The mast cell counts were generally low except for the control group (I: 1.05, II: 0.35, III: 0.38, IV: 0.20, V: 0.37), however, it was not statistically significant (p=0.066).
CONCLUSION
The gel barriers were shown to be partly efficient in inhibiting the formation of postoperative adhesions and might provide an option for abdominal surgery to reduce postoperative adhesions. The LMWH and COX-2 inhibitor had been known for their inhibitor effect of fibrin formation and anti-angiogenic/anti-fibroblastic activity, respectively. However, their preventive effects of adhesion and fibrosis were found to be obscure.

Keyword

Adhesion prevention; cyclo-oxygenase-2 inhibitor; low molecular weight heparin; hyaluronic acid/carboxymethylcellulose

MeSH Terms

Animals
Carboxymethylcellulose Sodium/metabolism
Cyclooxygenase 2 Inhibitors/*pharmacology
Heparin, Low-Molecular-Weight/*pharmacology
Male
Rats
Rats, Sprague-Dawley
Tissue Adhesions/*prevention & control
Carboxymethylcellulose Sodium
Cyclooxygenase 2 Inhibitors
Heparin, Low-Molecular-Weight

Figure

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  Fig. 1 The cecum was rubbed until subserosal haemorrhage and punctate bleeding developed.

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  Fig. 2 The Grade of fibrosis. (A) Grade 0: no collagenous fibrosis in the bowel wall. (B) Grade 1: the mild degree of collagenous fibrosis in the perihepatic soft tissue. (C) Grade 2: the moderate degree of collagenous fibrosis involving colonic mucosa, muscle layer, and pericoloic fat tissue. (D) Grade 3: the extensive collagenous fibrosis in the whole layer of colonic wall with mucosal ulceration (Under the 10 high power fields).

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  Fig. 3 Lymphocyte counts according to the groups. HA/CMC, hyaluronic acid/carboxymethylcellulose; LMWH, low molecular weight heparin; COX-2 inhibitor, cyclo-oxygenase-2 inhibitor; HPF, high power fields.

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  Fig. 4 Mast cell counts according to the groups. HA/CMC, hyaluronic acid/carboxymethylcellulose; LMWH, low molecular weight heparin; COX-2 inhibitor, cyclo-oxygenase-2 inhibitor; HPF, high power fields.

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